Incidence and outcomes of healthcare-associated COVID-19 infections: significance of delayed diagnosis and correlation with staff absence

Khonyongwa, Kirstin; Taori, Surabhi; Soares, Ana Cibelli Nogueira; Desai, Nergish; Sudhanva, Malur; Bernal, William; Schelenz, Silke; Curran, Lisa A

doi:10.1101/2020.07.24.20148262

Cited by 12 publications

(21 citation statements)

References 10 publications

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“…There is a growing international literature on nosocomial SARS-CoV-2 infection, from single ward or department reports, [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] to hospital-wide studies, [24] , [25] , [26] but only one (from Malta) based on limited national surveillance data. 27 The lull between phases of the pandemic in Europe has allowed prospective studies to be planned, but these have yet to report.…”

Section: Discussionmentioning

confidence: 99%

Healthcare-associated COVID-19 in England: A national data linkage study

Bhattacharya

Collin

Stimson

et al. 2021

Journal of Infection

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Objectives : Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. Methods : Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test <14 days pre-admission, up to day 2 of admission; hospital-onset indeterminate healthcare-associated, first positive on day 3-7; hospital-onset probable healthcare-associated, first positive on day 8-14; hospital-onset definite healthcare-associated, first positive from day 15 of admission until discharge; community-onset possible healthcare-associated, first positive test ≤14 days post-discharge. Results : One-third (34.4%, 100,859/293,204) of all laboratory-confirmed COVID-19 cases were linked to a hospital record. Hospital-onset probable and definite cases represented 5.3% (15,564/293,204) of all laboratory-confirmed cases and 15.4% (15,564/100,859) of laboratory-confirmed cases among hospital patients. Community-onset community-acquired and community-onset possible healthcare-associated cases represented 86.5% (253,582/293,204) and 5.1% (14,913/293,204) of all laboratory-confirmed cases, respectively. Conclusions : Up to 1 in 6 SARS-CoV-2 infections among hospitalised patients with COVID-19 in England during the first 6 months of the pandemic could be attributed to nosocomial transmission, but these represent less than 1% of the estimated 3 million COVID-19 cases in this period.

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Section: Discussionmentioning

confidence: 99%

Healthcare-associated COVID-19 in England: A national data linkage study

Bhattacharya

Collin

Stimson

et al. 2021

Journal of Infection

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show abstract

“…There is a growing international literature on nosocomial SARS-CoV-2 infection, from single ward or department reports, 15-23 to hospital-wide studies, 24-26 but only one (from Malta) based on limited national surveillance data. 27 The lull between phases of the pandemic in Europe has allowed prospective studies to be planned, but these have yet to report.…”

Section: Discussionmentioning

confidence: 99%

Healthcare-associated COVID-19 in England: a national data linkage study

Bhattacharya¹,

Collin²,

Stimson³

et al. 2021

Preprint

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Objectives: Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. Methods: Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired (CO.CA), first positive test (FPT) <14 days pre-admission, up to day 2 of admission; hospital-onset indeterminate healthcare-associated (HO.iHA), FPT on day 3-7; hospital-onset probable healthcare-associated (HO.pHA), FPT on day 8-14; hospital-onset definite healthcare-associated (HO.HA), FPT from day 15 of admission until discharge; community-onset possible healthcare-associated (CO.pHA), FPT ≤14 days post-discharge. Results: One-third (34.4%, 100,859/293,204) of all laboratory-confirmed COVID-19 cases were linked to a hospital record. HO.pHA and HO.HA cases represented 5.3% (15,564/293,204) of all laboratory-confirmed cases and 15.4% (15,564/100,859) of laboratory-confirmed cases among hospital patients. CO.CA and CO.pHA cases represented 86.5% (253,582/293,204) and 5.1% (14,913/293,204) of all laboratory-confirmed cases, respectively. Conclusions: Up to 1 in 6 SARS-CoV-2 infections among hospitalised patients with COVID-19 in England during the first 6 months of the pandemic could be attributed to nosocomial transmission, but these represent less than 1% of the estimated 3 million COVID-19 cases in this period.

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“…A further 48 studies were excluded as they did not report mortality within both community and nosocomial-acquired COVID-19 patient groups. This left 21 studies for primary meta-analysis (9)(10)(11)(12)(13)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46), summarised in…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Critical care admission rates were reported in 8 studies reporting nosocomial outbreaks (11,13,34,39,42,44,45,47); with a crude rate of 27/252 (10.7%) in patients with nosocomial COVID-19 compared to 359/1396 (25.7%) in those hospitalised with community-acquired COVID-19. Meta-analysis is shown in Figure 4, with the pooled relative risk indicating this trend did not reach statistical significance (RR= 0.70, 95% CI: 0.48 to 1.03).…”

Section: Meta-analysis Of Critical Care Admissionmentioning

confidence: 99%

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A systematic review and meta-analysis of inpatient mortality associated with nosocomial and community COVID-19 exposes the vulnerability of immunosuppressed adults

Ponsford

Ward

Stoneham

et al. 2021

Preprint

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Background: Little is known about the mortality of hospital-acquired (nosocomial) COVID-19 infection globally. We investigated the risk of mortality and critical care admission in hospitalised adults with nosocomial COVID-19, relative to adults requiring hospitalisation due to community-acquired infection. Methods: We systematically reviewed the peer-reviewed and pre-print literature from 1/1/2020 to 9/2/2021 without language restriction for studies reporting outcomes of nosocomial and community-acquired COVID-19. We performed a random effects meta-analysis (MA) to estimate the 1) relative risk of death and 2) critical care admission, stratifying studies by patient cohort characteristics and nosocomial case definition. Results: 21 studies were included in the primary MA, describing 8,246 admissions across 8 countries during the first wave, comprising 1517 probable or definite nosocomial COVID-19, and 6729 community-acquired cases. Across all studies, the risk of mortality was 1.31 times greater in patients with nosocomial infection, compared to community-acquired (95% CI: 1.01 to 1.70). Rates of critical care admission were similar between groups (Relative Risk, RR=0.74, 95% CI: 0.50 to 1.08). Immunosuppressed patients diagnosed with nosocomial COVID-19 were twice as likely to die in hospital as those admitted with community-acquired infection (RR=2.14, 95% CI: 1.76 to 2.61). Conclusions: Adults who acquire SARS-CoV-2 whilst already hospitalised are at greater risk of mortality compared to patients admitted following community-acquired infection; this finding is largely driven by a substantially increased risk of death in individuals with malignancy or who had undergone transplantation. These findings inform public health and infection control policy, and argue for individualised clinical interventions to combat the threat of nosocomial COVID-19, particularly for immunosuppressed groups. Systematic review registration: PROSPERO CRD42021249023

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Incidence and outcomes of healthcare-associated COVID-19 infections: significance of delayed diagnosis and correlation with staff absence

Cited by 12 publications

References 10 publications

Healthcare-associated COVID-19 in England: A national data linkage study

Healthcare-associated COVID-19 in England: A national data linkage study

Healthcare-associated COVID-19 in England: a national data linkage study

A systematic review and meta-analysis of inpatient mortality associated with nosocomial and community COVID-19 exposes the vulnerability of immunosuppressed adults

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